Anti‐Viral Treatment Eligibility and Treatment Uptake Among People With Chronic Hepatitis B in Australia: The REACH ‐B Study

Treatment indication for chronic hepatitis B (CHB) varies across clinical guidelines. This study evaluated treatment eligibility and uptake in a large Australian cohort of people with CHB. The REACH-B study recruited people with CHB managed through a national network of healthcare services. Participants were categorised into three groups: (1) receiving antiviral therapy; (2) untreated despite eligibility; (3) untreated and ineligible. Treatment eligibility was determined using Australian Pharmaceutical Benefits Scheme (PBS) criteria, and by international clinical guidelines. Among 3648 participants (56% male; median age 48 years; 49% born in North-East or South-East Asia; 27% First Nations Australians), 14% were HBeAg positive and 7% had cirrhosis. Overall, 47% (n = 1666) were on antiviral therapy, 45% (n = 1573) were untreated and ineligible and 7% (n = 251) were untreated despite eligibility based on Australian PBS criteria. In adjusted analysis, the likelihood of remaining untreated despite eligibility was higher among women (aOR 1.59, 95% CI 1.34, 1.88) and younger participants (age 41-60 vs. > 60 years: aOR 1.51, 95% CI 1.01-2.28; ≤ 40 vs. > 60 years: aOR 2.65, 95% CI 1.60, 4.40). The proportion untreated despite eligibility increased to 13% when applying 2024 World Health Organisation guidelines and ranged 2%-44% based on other guidelines, highlighting the variability across the guidelines. In conclusion, among REACH-B participants, most eligible individuals receive treatment. Lower treatment uptake among women and younger people despite eligibility partly reflects lower threshold for elevated ALT in women, and clinician determination of non-CHB related ALT elevation. As treatment guidelines evolve and eligibility criteria broaden, monitoring treatment patterns is important.

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Publication Details

Journal
Journal of Viral Hepatitis
Published
2026-11-02
DOI
https://doi.org/10.1111/jvh.70238
Primary Topic
Hepatitis B Virus Studies
Type
article
Field-Weighted Citation Impact
0.00

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article

Anti‐Viral Treatment Eligibility and Treatment Uptake Among People With Chronic Hepatitis B in Australia: The REACH ‐B Study

Tracey Brown, Lien Tran, Behzad Hajarizadeh, Jacob George et al.
2 links
Journal of Viral Hepatitis
Hepatitis B Virus Studies
article

Anti‐Viral Treatment Eligibility and Treatment Uptake Among People With Chronic Hepatitis B in Australia: The REACH ‐B Study

Tracey Brown, Lien Tran, Behzad Hajarizadeh, Jacob George, Robert Monaghan, Nicole L. Allard, Josh Hanson, Thomas Tu, Joanne M. Carson, Amanda Erratt, James P. O’Beirne, Lester Mascarenhas, Renjy Nelson, Gregory J. Dore, Amanda Wade, Tasnim Hasan, Marianne Martinello, Jessica Carter, Jane Davies, G V T Matthews, Elise T.-V. Tu, Benjamin C Cowie, Sarah Thomas, Ian Wong, Marilou Capati, Stephanie Howard, Georgina Trotter, the REACH‐B Study Group, Lloyd Nash
article en

Abstract

Treatment indication for chronic hepatitis B (CHB) varies across clinical guidelines. This study evaluated treatment eligibility and uptake in a large Australian cohort of people with CHB. The REACH-B study recruited people with CHB managed through a national network of healthcare services. Participants were categorised into three groups: (1) receiving antiviral therapy; (2) untreated despite eligibility; (3) untreated and ineligible. Treatment eligibility was determined using Australian Pharmaceutical Benefits Scheme (PBS) criteria, and by international clinical guidelines. Among 3648 participants (56% male; median age 48 years; 49% born in North-East or South-East Asia; 27% First Nations Australians), 14% were HBeAg positive and 7% had cirrhosis. Overall, 47% (n = 1666) were on antiviral therapy, 45% (n = 1573) were untreated and ineligible and 7% (n = 251) were untreated despite eligibility based on Australian PBS criteria. In adjusted analysis, the likelihood of remaining untreated despite eligibility was higher among women (aOR 1.59, 95% CI 1.34, 1.88) and younger participants (age 41-60 vs. > 60 years: aOR 1.51, 95% CI 1.01-2.28; ≤ 40 vs. > 60 years: aOR 2.65, 95% CI 1.60, 4.40). The proportion untreated despite eligibility increased to 13% when applying 2024 World Health Organisation guidelines and ranged 2%-44% based on other guidelines, highlighting the variability across the guidelines. In conclusion, among REACH-B participants, most eligible individuals receive treatment. Lower treatment uptake among women and younger people despite eligibility partly reflects lower threshold for elevated ALT in women, and clinician determination of non-CHB related ALT elevation. As treatment guidelines evolve and eligibility criteria broaden, monitoring treatment patterns is important.

Journal of Viral HepatitisVol. 33(12)
The University of Sydney (AU), Royal Adelaide Hospital (AU), The Royal Melbourne Hospital (AU), Barwon Health (AU), Cairns Hospital (AU), Blacktown & Mount Druitt Hospital (AU), Westmead Hospital (AU), UNSW Sydney (AU), Menzies School of Health Research (AU), St Vincent's Hospital Sydney (AU), Queen Elizabeth Hospital (AU), Sunshine Coast University Hospital (AU), Peter Doherty Institute (AU), WA Country Health Service (AU), Westmead Institute for Medical Research (AU), Kirby Institute (AU)
Australian Centre for HIV and Hepatitis Virology Research, Department of Health and Aged Care, Australian Government, National Health and Medical Research Council
Good health and well-being, Reduced inequalities
Openalex Percentile: Top 14%
Hepatitis B Virus Studies
DOIOpen Access PDFOpenAlex
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